Materiały źródłowe

• #1 Bronchiectasis Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiectasis/symptoms-diagnosis

  How Is Bronchiectasis Diagnosed? […] Bronchiectasis is an under-diagnosed condition. with many patients being incorrectly diagnosed with other lung diseases. Early diagnosis is important to prevent further lung damage. If your healthcare provider suspects bronchiectasis, they will want a detailed family history and blood tests to determine whether you may have an underlying condition that could cause bronchiectasis. These blood tests can also tell your healthcare provider if you have low levels of infection-fighting blood cells. […] A chest X-ray or CT scan are the most common ways to diagnose bronchiectasis. Both tests create detailed images of your lungs, heart or airways. […] Lung function tests can determine how well your lungs are working. […] A sputum culture can tell your doctor if bacteria is in your lungs. […] A sweat test may be ordered to determine if you have cystic fibrosis. […] In severe cases when bronchiectasis isnt responding to treatment, doctors may recommend a bronchoscopy. This flexible, narrow tube is inserted into the airways to help find blockages and sources of infection.

• #1 Bronchiectasis – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/bronchiectasis/diagnosis

  If bronchiectasis is suspected, your healthcare provider will first take a detailed family and medical history to determine whether you have an underlying lung condition that can cause bronchiectasis. Your provider may think you have bronchiectasis if you have certain symptoms, including a daily cough that produces large amounts of sputum (a mix of saliva and fluid from the lungs that may contain mucus) for at least 8 weeks. Your provider will also use one or more imaging tests for lung disease to confirm a diagnosis. […] A chest computed tomography (CT) scan is a key test for bronchiectasis, because it enables your healthcare provider to see what is happening in your lungs. The CT scan is able to look at your lungs in more fine detail and see where in the lungs the airways may be irritated or damaged. For a diagnosis, both images from a CT scan and clinical symptoms must be present.

• #2 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  Bronchiectasis is a chronic lung disease characterised by recurrent infection, inflammation, persistent cough and sputum production. […] Initial assessments and long-term treatment plans that include both pharmacological and non-pharmacological treatments, however, should be undertaken in collaboration with a secondary care team that includes physiotherapists and specialists in respiratory medicine. […] Overall goals of therapy are to prevent exacerbations, improve symptoms, improve quality of life and preserve lung function. […] Prompt treatment of exacerbations with antibiotic therapy is important to limit the impact of exacerbations on quality of life and lung function decline. […] It is important for the primary care provider to work with secondary care providers to develop an individualised treatment plan to optimise care with the goal to delay disease progression.

• #2 Bronchiectasis | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/bronchiectasis/

  Bronchiectasis can be difficult to accurately diagnose and properly treat. Clinicians need to be aware of the causes and presentation of bronchiectasis, and how to properly diagnose and treat this condition. […] Patients with bronchiectasis present with nonspecific symptoms, including cough, excess sputum production, rhinosinusitis, dyspnea, fatigue, hemoptysis, and chest pain. […] Review of the patients medical history should focus on recurrent infections; cystic fibrosis or other lung diseases; autoimmune or connective tissue diseases; and congenital malformations. A previous diagnosis of any of these conditions may suggest bronchiectasis. […] Patients presenting with signs and symptoms that suggest bronchiectasis should undergo evaluation with chest imaging, including x-ray and computed tomography; pulmonary function testing measuring forced expiratory volume in the first second (FEV1), lung volumes, forced vital capacity, and diffusion capacity; and sputum analyses for mycobacterial, viral, or fungal infections.

• #3 Bronchiectasis Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiectasis/symptoms-diagnosis

  How Is Bronchiectasis Diagnosed? […] Bronchiectasis is an under-diagnosed condition. with many patients being incorrectly diagnosed with other lung diseases. Early diagnosis is important to prevent further lung damage. If your healthcare provider suspects bronchiectasis, they will want a detailed family history and blood tests to determine whether you may have an underlying condition that could cause bronchiectasis. These blood tests can also tell your healthcare provider if you have low levels of infection-fighting blood cells. […] A chest X-ray or CT scan are the most common ways to diagnose bronchiectasis. Both tests create detailed images of your lungs, heart or airways. […] Lung function tests can determine how well your lungs are working. […] A sputum culture can tell your doctor if bacteria is in your lungs. […] A sweat test may be ordered to determine if you have cystic fibrosis. […] In severe cases when bronchiectasis isnt responding to treatment, doctors may recommend a bronchoscopy. This flexible, narrow tube is inserted into the airways to help find blockages and sources of infection.

• #3 Diagnosing bronchiectasis | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/healthcare-professionals/bronchiectasis/diagnosing-bronchiectasis

  The diagnosis of bronchiectasis is made from a high-resolution CT scan. […] Usually the patient journey starts with a patient presenting with symptoms to their GP practice. They should be assessed, relevant tests performed and then referred for a CT scan if appropriate. Most patients then receive their diagnosis from a specialist in secondary care. […] After diagnosis, patients should be seen by the specialist respiratory team to create a care plan thats agreed together with the patient, the specialist team and the primary care team. […] A recurrent productive cough (one that has lasted for 8 weeks or longer) is a key sign of bronchiectasis. […] Sputum colour can suggest infection (if green or brown) and any blood in the sputum (haemoptysis). […] Haemoptysis can be a sign of bronchiectasis but is also associated with lung cancer so will need further investigation.

• #4

  https://link.springer.com/article/10.1007/s13665-023-00336-7

  The purpose of this review is to understand the criteria for clinical and radiologic diagnosis of bronchiectasis and the algorithmic approach for diagnosing its etiology. […] The clinical diagnosis requires presence of cough and/or sputum production on most days of the week and history of infective exacerbations. Radiologic diagnosis requires identification of abnormally dilated airways on a chest computed tomogram. […] A correct diagnosis of disease and its etiology is the first step in planning an appropriate therapeutic strategy.

• #5 Bronchiectasis – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/bronchiectasis/diagnosis

  If bronchiectasis is suspected, your healthcare provider will first take a detailed family and medical history to determine whether you have an underlying lung condition that can cause bronchiectasis. Your provider may think you have bronchiectasis if you have certain symptoms, including a daily cough that produces large amounts of sputum (a mix of saliva and fluid from the lungs that may contain mucus) for at least 8 weeks. Your provider will also use one or more imaging tests for lung disease to confirm a diagnosis. […] A chest computed tomography (CT) scan is a key test for bronchiectasis, because it enables your healthcare provider to see what is happening in your lungs. The CT scan is able to look at your lungs in more fine detail and see where in the lungs the airways may be irritated or damaged. For a diagnosis, both images from a CT scan and clinical symptoms must be present.

• #6 Indicators Leading to Bronchiectasis Testing and Diagnosis

  https://www.ajmc.com/view/indicators-leading-to-bronchiectasis-testing-and-diagnosis

  Notable signs and symptoms distinguishing bronchiectasis from other pulmonary disease states are discussed. […] Most patients sent to specialty centers for bronchiectasis already have the diagnosis from CT imaging. The main diagnostic issue is identifying patients who warrant getting a CT scan to diagnose bronchiectasis earlier. Patients generally have chronic cough, usually productive with chronic purulent sputum from bacterial infection. These symptoms should prompt consideration of bronchiectasis and obtaining a CT scan. Other clues are exacerbations with chest pain or hemoptysis, which are more common in bronchiectasis than chronic obstructive pulmonary disease (COPD) or asthma. Delayed diagnosis often occurs because symptoms can mimic COPD and asthma. However, the history of chronic colored sputum production differentiates bronchiectasis. Even COPD patients with daily cough usually only have purulent sputum during acute exacerbations rather than daily.

• #7 Diagnosing Bronchiectasis | NYU Langone Health

  https://nyulangone.org/conditions/bronchiectasis/diagnosis

  At NYU Langone, our pulmonary specialists have extensive experience in diagnosing and managing bronchiectasis, a lung condition that causes scarring and widening in the airways. […] To diagnose bronchiectasis, an NYU Langone pulmonologist first takes a medical history. He or she asks whether you have any conditions associated with bronchiectasis, such as rheumatoid arthritis, or if you had severe lung infections as a child. Your doctor may also recommend the following tests. […] A chest X-ray uses electromagnetic radiation to create pictures of structures in the chest, such as your heart and lungs. It can detect lung scarring, a sign of bronchiectasis, and it can help rule out other pulmonary conditions. […] If a chest X-ray doesn’t provide enough detail, your pulmonologist may order a CT scan, which uses X-rays and a computer to create three-dimensional, cross-sectional images of the body. A CT scan may reveal dilated, thickened airways, which are commonly found in bronchiectasis.

• #8 Recommendations for aetiological diagnosis of bronchiectasis | Pulmonology

  https://journalpulmonology.org/en-recommendations-for-aetiological-diagnosis-bronchiectasis-articulo-S2173511516300033

  The number of bronchiectasis diagnoses has increased in the last two decades due to several factors. […] Research carried out over the last years showed that an aetiological diagnosis could change the approach and treatment of a relevant percentage of patients and consequently the prognosis. […] Currently, systematic investigation into aetiology, particularly of those disorders that can be subject to specific treatment, is recommended. […] In conclusion, after diagnosing BE a systematic aetiologic investigation should be undertaken. […] A systematic investigation of the underlying aetiology undertaken according to a predetermined algorithm increases the likelihood of obtaining a diagnosis with better resource management. […] Clinical history should include onset age, presenting symptoms, clinical evolution, previously diagnosed diseases, risk exposures, infertility history, non-respiratory symptoms and family history including consanguinity data.

• #9 Bronchiectasis Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiectasis/symptoms-diagnosis

  How Is Bronchiectasis Diagnosed? […] Bronchiectasis is an under-diagnosed condition. with many patients being incorrectly diagnosed with other lung diseases. Early diagnosis is important to prevent further lung damage. If your healthcare provider suspects bronchiectasis, they will want a detailed family history and blood tests to determine whether you may have an underlying condition that could cause bronchiectasis. These blood tests can also tell your healthcare provider if you have low levels of infection-fighting blood cells. […] A chest X-ray or CT scan are the most common ways to diagnose bronchiectasis. Both tests create detailed images of your lungs, heart or airways. […] Lung function tests can determine how well your lungs are working. […] A sputum culture can tell your doctor if bacteria is in your lungs. […] A sweat test may be ordered to determine if you have cystic fibrosis. […] In severe cases when bronchiectasis isnt responding to treatment, doctors may recommend a bronchoscopy. This flexible, narrow tube is inserted into the airways to help find blockages and sources of infection.

• #10 Radiology – Bronchiectasis

  https://bronchiectasis.com.au/bronchiectasis/diagnosis-2/radiology

  Imaging plays a pivotal role in the diagnosis of bronchiectasis. High-resolution computed tomography (HRCT) is the cornerstone in the radiological diagnosis of clinically suspicious cases. HRCT is the most sensitive and specific non-invasive method for diagnosing bronchiectasis. […] HRCT continues to be the gold standard for establishing the diagnosis, the anatomic extent and severity of bronchiectasis.

• #11 How is it diagnosed? – Bronchiectasis

  https://bronchiectasis.com.au/bronchiectasis/diagnosis-2/how-is-it-diagnosed

  Bronchiectasis relies on both a clinical and radiological diagnosis. […] A high resolution CT scan establishes the diagnosis of bronchiectasis. […] c-HRCT remains the diagnostic gold standard.

• #12 Bronchiectasis – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/bronchiectasis/diagnosis

  If bronchiectasis is suspected, your healthcare provider will first take a detailed family and medical history to determine whether you have an underlying lung condition that can cause bronchiectasis. Your provider may think you have bronchiectasis if you have certain symptoms, including a daily cough that produces large amounts of sputum (a mix of saliva and fluid from the lungs that may contain mucus) for at least 8 weeks. Your provider will also use one or more imaging tests for lung disease to confirm a diagnosis. […] A chest computed tomography (CT) scan is a key test for bronchiectasis, because it enables your healthcare provider to see what is happening in your lungs. The CT scan is able to look at your lungs in more fine detail and see where in the lungs the airways may be irritated or damaged. For a diagnosis, both images from a CT scan and clinical symptoms must be present.

• #13 Bronchiectasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/296961-overview

  Diagnosis is usually based on a compatible clinical history of chronic respiratory symptoms, such as a daily cough and viscid sputum production, and characteristic radiographic findings on CT scans, such as bronchial wall thickening and luminal dilatation. […] Expected general findings on posterior-anterior and lateral chest radiographs include the following: Increased pulmonary markings. Honeycombing. Atelectasis. Pleural changes. […] Specific findings on chest radiographs may include the following: Linear lucencies and parallel markings radiating from the hila (tram tracking) in cylindrical bronchiectasis. Dilated bronchi in varicose bronchiectasis. Clustered cysts in cystic bronchiectasis. […] Noteworthy CT findings in bronchiectasis include the following: Cylindrical bronchiectasis has parallel tram track lines, or it may have a signet-ring appearance composed of a dilated bronchus cut in a horizontal section with an adjacent pulmonary artery representing the stone. The diameter of the bronchus lumen is normally 1-1.5 times that of the adjacent vessel; a diameter greater than 1.5 times that of the adjacent vessel suggests bronchiectasis. Varicose bronchiectasis has irregular or beaded bronchi, with alternating areas of dilatation and constriction. Cystic bronchiectasis has large cystic spaces and a honeycomb appearance; this contrasts with the blebs of emphysema, which have thinner walls and are not accompanied by proximal airway abnormalities.

• #14 Bronchiectasis Workup: Approach Considerations, Sputum Analysis, CBC Count

  https://emedicine.medscape.com/article/296961-workup

  In a typical patient, bronchiectasis is suspected on the basis of the clinical presentation, especially if purulent sputum is present and other conditions (ie, pneumonia, lung abscess) have been ruled out. A sputum analysis may be used to further strengthen clinical suspicion. […] The diagnosis of bronchiectasis should require at least one of the currently recognized diagnostic radiological criteria in combination with the clinical syndrome of bronchiectasis. […] Patients who meet a definition of clinically significant bronchiectasis will have at least two of the following: (1) a cough most days of the week (2) sputum production most days of the week (3) a history of exacerbations. […] Radiologic definition of bronchiectasis, the patient has at least one of the following on a high-resolution chest CT scan (1) An inner airway artery diameter ratio of = 1.0 (2) An outer airway artery diameter ratio of = 1.0 (3) A lack of tapering of the airways (4) Visibility of airways in the periphery.

• #15 Bronchiectasis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/bronchiectasis?lang=us

  Bronchial dilatation is present if the bronchial diameter exceeds the diameter of the accompanying pulmonary artery on CT (signet ring sign). Absence of normal tapering and abnormal visualization of peripheral airways within 1 cm of the pleural surface are common signs of bronchiectasis. Thickened bronchial walls and adjacent scarring are common. Irreversibility must be established to distinguish bronchiectasis from bronchial dilatation. […] A number of features are helpful in diagnosing bronchiectasis: bronchus visualized within 1 cm of the pleural surface, especially true of lung adjacent to costal pleura, most helpful sign for early cylindrical change; lack of tapering; increased bronchoarterial ratio; diameter of a bronchus should measure approximately 0.65-1.0 times that of the adjacent pulmonary artery branch; greater than 1.5 indicates bronchiectasis. […] Signs described on CT include: tram-track sign, signet ring sign, string of pearls sign, bunch of grapes sign.

• #16 Bronchiectasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/296961-overview

  Diagnosis is usually based on a compatible clinical history of chronic respiratory symptoms, such as a daily cough and viscid sputum production, and characteristic radiographic findings on CT scans, such as bronchial wall thickening and luminal dilatation. […] Expected general findings on posterior-anterior and lateral chest radiographs include the following: Increased pulmonary markings. Honeycombing. Atelectasis. Pleural changes. […] Specific findings on chest radiographs may include the following: Linear lucencies and parallel markings radiating from the hila (tram tracking) in cylindrical bronchiectasis. Dilated bronchi in varicose bronchiectasis. Clustered cysts in cystic bronchiectasis. […] Noteworthy CT findings in bronchiectasis include the following: Cylindrical bronchiectasis has parallel tram track lines, or it may have a signet-ring appearance composed of a dilated bronchus cut in a horizontal section with an adjacent pulmonary artery representing the stone. The diameter of the bronchus lumen is normally 1-1.5 times that of the adjacent vessel; a diameter greater than 1.5 times that of the adjacent vessel suggests bronchiectasis. Varicose bronchiectasis has irregular or beaded bronchi, with alternating areas of dilatation and constriction. Cystic bronchiectasis has large cystic spaces and a honeycomb appearance; this contrasts with the blebs of emphysema, which have thinner walls and are not accompanied by proximal airway abnormalities.

• #17 Bronchiectasis Workup: Approach Considerations, Sputum Analysis, CBC Count

  https://emedicine.medscape.com/article/296961-workup

  In a typical patient, bronchiectasis is suspected on the basis of the clinical presentation, especially if purulent sputum is present and other conditions (ie, pneumonia, lung abscess) have been ruled out. A sputum analysis may be used to further strengthen clinical suspicion. […] The diagnosis of bronchiectasis should require at least one of the currently recognized diagnostic radiological criteria in combination with the clinical syndrome of bronchiectasis. […] Patients who meet a definition of clinically significant bronchiectasis will have at least two of the following: (1) a cough most days of the week (2) sputum production most days of the week (3) a history of exacerbations. […] Radiologic definition of bronchiectasis, the patient has at least one of the following on a high-resolution chest CT scan (1) An inner airway artery diameter ratio of = 1.0 (2) An outer airway artery diameter ratio of = 1.0 (3) A lack of tapering of the airways (4) Visibility of airways in the periphery.

• #18 Bronchiectasis – EMCrit Project

  https://emcrit.org/ibcc/bronchiectasis/

  Bronchiectasis is defined as irreversible dilation of the bronchi, usually associated with chronic purulent sputum production. […] With increasing utilization of CT scans, it is increasingly common to detect the presence of bronchiectasis on CT scanning. However, this alone doesn’t necessarily indicate that the patient has bronchiectasis. Clinically significant bronchiectasis has been defined as follows: […] Radiology: at least one of the following features: Bronchial/artery ratio ~1.5. […] Clinical features: at least two of the following: A cough most days of the week. […] Sputum production most days of the week. […] A history of exacerbations.

• #19 Bronchiectasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/296961-overview

  Diagnosis is usually based on a compatible clinical history of chronic respiratory symptoms, such as a daily cough and viscid sputum production, and characteristic radiographic findings on CT scans, such as bronchial wall thickening and luminal dilatation. […] Expected general findings on posterior-anterior and lateral chest radiographs include the following: Increased pulmonary markings. Honeycombing. Atelectasis. Pleural changes. […] Specific findings on chest radiographs may include the following: Linear lucencies and parallel markings radiating from the hila (tram tracking) in cylindrical bronchiectasis. Dilated bronchi in varicose bronchiectasis. Clustered cysts in cystic bronchiectasis. […] Noteworthy CT findings in bronchiectasis include the following: Cylindrical bronchiectasis has parallel tram track lines, or it may have a signet-ring appearance composed of a dilated bronchus cut in a horizontal section with an adjacent pulmonary artery representing the stone. The diameter of the bronchus lumen is normally 1-1.5 times that of the adjacent vessel; a diameter greater than 1.5 times that of the adjacent vessel suggests bronchiectasis. Varicose bronchiectasis has irregular or beaded bronchi, with alternating areas of dilatation and constriction. Cystic bronchiectasis has large cystic spaces and a honeycomb appearance; this contrasts with the blebs of emphysema, which have thinner walls and are not accompanied by proximal airway abnormalities.

• #20 Bronchiectasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/296961-overview

  Diagnosis is usually based on a compatible clinical history of chronic respiratory symptoms, such as a daily cough and viscid sputum production, and characteristic radiographic findings on CT scans, such as bronchial wall thickening and luminal dilatation. […] Expected general findings on posterior-anterior and lateral chest radiographs include the following: Increased pulmonary markings. Honeycombing. Atelectasis. Pleural changes. […] Specific findings on chest radiographs may include the following: Linear lucencies and parallel markings radiating from the hila (tram tracking) in cylindrical bronchiectasis. Dilated bronchi in varicose bronchiectasis. Clustered cysts in cystic bronchiectasis. […] Noteworthy CT findings in bronchiectasis include the following: Cylindrical bronchiectasis has parallel tram track lines, or it may have a signet-ring appearance composed of a dilated bronchus cut in a horizontal section with an adjacent pulmonary artery representing the stone. The diameter of the bronchus lumen is normally 1-1.5 times that of the adjacent vessel; a diameter greater than 1.5 times that of the adjacent vessel suggests bronchiectasis. Varicose bronchiectasis has irregular or beaded bronchi, with alternating areas of dilatation and constriction. Cystic bronchiectasis has large cystic spaces and a honeycomb appearance; this contrasts with the blebs of emphysema, which have thinner walls and are not accompanied by proximal airway abnormalities.

• #21 Bronchiectasis A guide for primary care

  https://www.racgp.org.au/afp/2012/november/bronchiectasis

  This article will focus on non-CF bronchiectasis and aims to provide advice regarding in whom to suspect bronchiectasis and how to proceed with confirming or refuting a diagnosis. […] Bronchiectasis is classically defined as a pathological diagnosis typically confirmed by radiology. Bronchiectasis is characterised by abnormal, irreversible bronchial dilatation or a fixed increase in airway diameter. Bronchiectasis is currently usually diagnosed by a chest high-resolution computed tomography (c-HRCT) scan. […] In general, a diagnosis of bronchiectasis requires a clinically consistent history in association with evidence of fixed and abnormal bronchial dilatation. As highlighted earlier, evidence of bronchial dilatation is typically confirmed on c-HRCT. […] While plain chest X-ray may demonstrate large airway dilatation it is not sensitive (ie. a normal chest X-ray does not exclude bronchiectasis) nor does it provide an accurate measure of the extent of disease or any associated interstitial damage (eg. pulmonary fibrosis).

• #22 Diagnosing bronchiectasis | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/healthcare-professionals/bronchiectasis/diagnosing-bronchiectasis

  Many patients will have had exacerbations before they are diagnosed, because they have normalised their symptoms or dont realise that they are significant. […] Gastro-oesophageal reflux disease is common in bronchiectasis and associated with more frequent respiratory exacerbations. […] Chronic rhinosinusitis is present in up to 70% of cases of bronchiectasis and should be treated to protect the airways. […] A normal chest X-ray does not rule out bronchiectasis so if clinical suspicion remains high, refer to secondary care for a high-resolution CT chest scan. […] In bronchiectasis, the spirometry might be obstructive, restrictive or normal. […] Once your patient is diagnosed, the specialist team in secondary care will undertake additional blood testing for alpha-1 antitrypsin, immunoglobulins, auto antibodies, aspergillus and pneumococcal antibody levels.

• #23 Bronchiectasis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1007?locale=ko

  Bronchiectasis often presents with recurrent pulmonary infections, including a chronic daily productive cough with mucopurulent sputum production. […] High-resolution chest computed tomography is the confirmatory test. […] Diagnostic testing is geared toward identifying the underlying etiology, as treatment will be successful only if it treats both the bronchiectasis and any underlying disease process. […] A sputum sample should be obtained when the patient is in a stable state and during acute exacerbations. […] Maintenance aerosolized antibiotics may be used for treatment of severe bronchiectasis or recurrent Pseudomonas aeruginosa infections. […] Diagnostic tests include high-resolution chest CT, CXR, CBC, sputum culture and sensitivity, serum alpha-1 antitrypsin phenotype and level, serum immunoglobulins, sweat chloride test, rheumatoid factor, specific IgE or skin prick test to Aspergillus fumigatus, serum HIV antibody, nasal nitric oxide (NNO), and pulmonary function tests. […] Tests to consider include primary ciliary dyskinesia (PCD) testing, cystic fibrosis transmembrane regulator (CFTR) protein gene mutation testing, swallow study, pH monitoring of esophagus, 6-minute walk test, tuberculosis testing, and diagnostic bronchoscopy with bronchoalveolar lavage.

• #24 Diagnosing Bronchiectasis | NYU Langone Health

  https://nyulangone.org/conditions/bronchiectasis/diagnosis

  Your pulmonologist may want to test your sputum, or mucus, for bacteria to determine whether you have a lung infection. He or she collects a sample of coughed-up phlegm and sends it to the lab for examination. If any uncommon bacteria are found, your doctor may suspect bronchiectasis. […] A pulmonary function test is a group of tests used to assess lung function and possible damage. The tests measure the amount of air your lungs can hold, how quickly air is inhaled and exhaled, and how much oxygen is delivered to the blood through the lungs. […] If you have bronchiectasis and are not responding to treatment, your pulmonologist may want to perform a bronchoscopy to get a better look at your lungs for further evaluation.

• #25 Bronchiectasis Workup: Approach Considerations, Sputum Analysis, CBC Count

  https://emedicine.medscape.com/article/296961-workup

  Once the diagnosis is confirmed, additional laboratory testing may be useful to determine the underlying cause. […] However, high-resolution CT (HRCT) scanning is the criterion standard for the diagnosis of bronchiectasis as mentioned above. […] The anatomical distribution of bronchiectasis may be important in helping diagnose any associated condition or cause of bronchiectasis. […] The European Respiratory Society (ERS) guidelines for the management of adult bronchiectasis suggest the minimum bundle of etiological tests in adults with a new diagnosis of bronchiectasis. […] Cultures of respiratory secretions are obtained at the time of diagnosis, at regular intervals after that for surveillance, and at the time of exacerbations. […] A sputum analysis may reinforce the diagnosis of bronchiectasis and add significant information regarding potential etiologies.

• #26

  https://www.bronchiectasisandntminitiative.org/Learn-More/I-am-a-Patient-or-Caregiver/Diagnostic-Testing-and-Evaluation

  On initial evaluation, a doctor may order a chest X-ray, which is one type of imaging. Chest X-rays are not used to diagnose bronchiectasis or NTM lung disease but are generally done to rule out other chronic lung diseases or sudden illnesses or injuries. […] An HRCT, also known as a high-resolution CT scan, is a special type of CT scan. […] While a normal CT scan may be good enough to make a diagnosis of bronchiectasis for some patients, HRCT is considered the gold standard for the diagnosis and description of bronchiectasis. […] PFTs are different breathing tests that can help to measure how well the lungs work. […] Doctors order PFTs to look at how severe airflow obstruction (narrowing or blockages of the airways) is in patients with bronchiectasis and NTM lung disease. […] A sputum culture is a test used in those with lung infections to see what type(s) of bacteria (if any) are in the mucus that is coughed out. […] When a lab can find out the type(s) of bacteria that are in your mucus, your doctor can decide if antibiotics are needed and, if so, which ones will be helpful in treating the infection.

• #27 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  If HRCT is not indicative of bronchiectasis, then the diagnosis can be excluded. […] Knowing which pathogen is present, if any, will help determine the most effective antibiotic treatment. […] A regular chest x-ray may be insensitive to the changes caused by bronchiectasis. […] Negative sputum cultures do not exclude a diagnosis of bronchiectasis. […] The bronchiectasis severity index has recently been developed and extensively validated and may enhance the ability of physicians to predict outcomes and better manage patient care. […] The main goals of treatment are to reduce exacerbations, preserve lung function and improve the patients quality of life. […] Specific management strategies for bronchiectasis depend on the underlying severity and cause of disease. […] Patients with mild or moderate bronchiectasis are often managed and monitored in the primary care setting.

• #28 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  Bronchiectasis is a chronic, debilitating respiratory condition that affects people of all ages. It is most prevalent in women and those older than 60 years, and prevalence is increasing. Patients have daily excessive sputum and associated symptoms, recurrent chest infections and impaired health-related quality of life. In North America, management guidelines are lacking. This review discusses best evidence to guide the long-term management of noncystic fibrosis bronchiectasis in adults, focusing on the two most common single-entity types of bronchiectasis in adults: idiopathic and postinfectious bronchiectasis. […] In patients presenting with clinical features suggestive of bronchiectasis, appropriate baseline investigations include a chest radiograph, lung function tests (forced expiratory volume in the first second [FEV1], forced vital capacity [FVC], lung volumes and diffusion capacity) and sputum bacteriological culture. These provide useful information for diagnostic triage and surveillance, although they lack specificity and sensitivity to the actual diagnosis of bronchiectasis.

• #29 Bronchiectasis Diagnosis | Temple Health

  https://www.templehealth.org/services/conditions/bronchiectasis/diagnosis

  Pulmonary function tests: Measures how much air you can breathe in and out, how fast you can breathe out, and how well your lungs deliver oxygen to the blood. The most common lung function test is called spirometry and measures how much air you can breathe out after taking a deep breath and how fast you can expel the air. […] Blood test: May show whether bronchiectasis is caused by an underlying condition, such as cystic fibrosis, or whether an infection that may be causing lung damage is present. […] Sputum culture: Involves examining a sputum (mucus) sample under a microscope to determine whether certain bacteria or fungi are present.

• #30 Bronchiectasis – Pulmonary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pulmonary-disorders/bronchiectasis-and-atelectasis/bronchiectasis

  Bronchiectasis refers to dilation, thickening, and destruction of larger bronchi caused by chronic infection and inflammation. […] Diagnosis is based on history and imaging, usually involving high-resolution computed tomography, though standard chest x-radiographs may be diagnostic. […] Diagnosis is based on history, physical examination, and radiologic testing, beginning with a chest radiograph. […] Chronic bronchitis may mimic bronchiectasis clinically, but bronchiectasis is distinguished by increased purulence and volume of daily sputum and by dilated airways shown on imaging studies. […] High-resolution CT is the imaging modality of choice to definitively diagnose as well as define the extent of bronchiectasis. […] Typical CT findings include airway dilation (in which the inner lumen of 2 or more airways exceeds the diameter of the adjacent artery) and the signet ring sign, in which a thickened, dilated airway appears adjacent to a smaller artery in transaxial view.

• #31 Bronchiectasis – Pulmonary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pulmonary-disorders/bronchiectasis-and-atelectasis/bronchiectasis

  Pulmonary function tests (PFTs) can be helpful for documenting baseline function and for monitoring disease progression; however, PFT results must be interpreted in the context of the evolving disease course and overall clinical picture. […] During an exacerbation-free period, all patients should have expectorated or induced sputum cultured to determine the predominant colonizing bacteria and their sensitivities. […] A complete blood count (CBC) and differential can help determine the severity of disease activity and identify eosinophilia, which may suggest complicating diagnoses such as allergic asthma, or ABPA. […] Clinically significant nontuberculous mycobacterial infection is diagnosed by isolating these organisms in 2 cultures from serial sputum samples (expectorated or induced) or a single bronchoalveolar lavage sample.

• #32 Diagnosing bronchiectasis | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/healthcare-professionals/bronchiectasis/diagnosing-bronchiectasis

  Many patients will have had exacerbations before they are diagnosed, because they have normalised their symptoms or dont realise that they are significant. […] Gastro-oesophageal reflux disease is common in bronchiectasis and associated with more frequent respiratory exacerbations. […] Chronic rhinosinusitis is present in up to 70% of cases of bronchiectasis and should be treated to protect the airways. […] A normal chest X-ray does not rule out bronchiectasis so if clinical suspicion remains high, refer to secondary care for a high-resolution CT chest scan. […] In bronchiectasis, the spirometry might be obstructive, restrictive or normal. […] Once your patient is diagnosed, the specialist team in secondary care will undertake additional blood testing for alpha-1 antitrypsin, immunoglobulins, auto antibodies, aspergillus and pneumococcal antibody levels.

• #33 Bronchiectasis: diagnosis, treatment and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/bronchiectasis-diagnosis-treatment-and-management

  Variable lung function tests can be seen in patients with bronchiectasis, even in people with more severe disease (some may have normal spirometry, a restrictive defect or airway obstruction). […] Despite being quite non-specific, chest x-rays are often the initial mode of imaging used for investigating bronchiectasis. However, changes are only notable in severe disease, therefore, a normal chest x-ray does not exclude bronchiectasis. A high-resolution CT scan of the chest is considered the radiological investigation of choice. […] If CT imaging shows localised disease, bronchoscopy is recommended to exclude an endobronchial lesion. Bronchoscopy with broncho-alveolar lavage is also useful in patients with suspected NTM infection who cannot produce regular sputum. […] The British Thoracic Society (BTS) guidelines define an exacerbation as needing antibiotics and an acute deterioration with worsening symptoms (cough, increased sputum volume or change of viscosity, increased sputum purulence with or without increasing wheeze, breathlessness, haemoptysis) and/or systemic upset.

• #34 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  The gold standard for confirming the diagnosis is high-resolution computed tomography scan of the chest, ideally done when the patient is clinically stable. Determination of the underlying cause may alter management in as many as 37% of adults presenting with bronchiectasis. […] Two validated severity scores are currently used in conjunction with clinical judgment: the FACED score and the Bronchiectasis Severity Index (BSI). The FACED score predicts risk of five-year mortality and is calculated using FEV1% predicted, age, chronic Pseudomonas colonization, extent of bronchiectasis (number of affected lobes) and Medical Research Council Dyspnea Scale score. The BSI can be calculated using an online tool. Predictive variables include age, body mass index, FEV1% predicted, Medical Research Council Dyspnea Scale score, lobes affected and evidence of chronic bacterial infection.

• #35 Bronchiectasis | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/bronchiectasis/

  High-resolution computed tomography scans provide greater detail about the extent and distribution of the disease, and are the gold standard for diagnosing bronchiectasis. […] Sputum analysis can identify the inciting bacteria, virus, or fungus of a bronchiectasis-related infection. […] Patients with suspected bronchiectasis should be evaluated with a complete blood cell count plus differential to assess for leukopenia and eosinophilia. […] The differential diagnosis for bronchiectasis should include conditions and diseases that also present with respiratory symptoms.

• #36 Spanish Guidelines on the Evaluation and Diagnosis of Bronchiectasis in Adults | Archivos de Bronconeumología

  https://www.archbronconeumol.org/en-spanish-guidelines-on-evaluation-diagnosis-articulo-S157921291730383X

  The cost of BE is high (the average cost of annual treatment in Spain is estimated to be close to 4700), and is greater the more severe the disease (around 10000 annually in severe cases), if there is coexisting COPD, a higher number of exacerbations, and when there is chronic bronchial Pseudomonas aeruginosa infection. […] HRCT is currently the gold standard for both diagnosis and to assess disease morphology, extent and progression (strong recommendation, high quality evidence). […] The presence of systemic inflammation, chronic bronchial P. aeruginosa infection and severe exacerbations have been associated with more rapid progression of BE.

• #37 Emerging Concepts in Bronchiectasis: Diagnosis, Pathophysiology, and Relevance in Lung Disease – European Medical Journal

  https://www.emjreviews.com/respiratory/symposium/emerging-concepts-in-bronchiectasis-diagnosis-pathophysiology-and-relevance-in-lung-disease-j160124/

  Trudzinski stressed that all patients with bronchiectasis should undergo an aetiological workup, which includes a review of their medical history, clinical findings, and radiological findings, and a minimum bundle of laboratory tests. […] The minimum bundle of aetiological tests recommended by the ERS for adults with a new diagnosis of bronchiectasis includes differential blood count to detect primary or secondary immunodeficiency, serum immunoglobins (total IgG, IgA, and IgM), and testing for allergic bronchopulmonary aspergillosis (ABPA). […] Trudzinski emphasised that following the ERS recommendations can help to understand the aetiology of bronchiectasis, and can lead to relevant changes in treatment and prognosis. […] However, she explained that once bronchiectasis has been accurately diagnosed, additional CT scans are rarely useful unless the clinical manifestations of the disease have changed considerably; in patients with relatively stable disease, Trudzinski tends to perform a CT scan every five years.

• #38 Bronchiectasis – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/bronchiectasis/diagnosis

  If your bronchiectasis doesn’t respond to treatment, your healthcare provider may recommend bronchoscopy. Providers use this procedure to look inside the airways, check for any blockages, show the source of any bleeding in your airways, and get samples from your lower airways to see whether there are any untreated infections.

• #39 Bronchiectasis – Wikipedia

  https://en.wikipedia.org/wiki/Bronchiectasis

  Laboratory tests that are commonly part of the initial evaluation include a complete blood count, sputum cultures for bacteria, mycobacteria, and fungi, testing for cystic fibrosis, and immunoglobulin levels. […] Lung function testing is used for the assessment and monitoring of functional impairment due to bronchiectasis. These tests may include spirometry and walking tests. […] Flexible bronchoscopy may be performed when sputum studies are negative and a focal obstructing lesion is suspected.

• #40 Bronchiectasis Diagnosis – Bronchiectasis News Today

  https://bronchiectasisnewstoday.com/bronchiectasis-diagnosis/

  A mucus sample will be tested to determine if there are bacterial infections or other microbes. […] Lung function tests will measure the volume of air that is inhaled and exhaled, how fast it is exhaled, and how well the lungs deliver oxygen to the blood. These tests are helpful to evaluate whether there is lung damage. […] A sweat test is conducted in order to rule out cystic fibrosis (people with cystic fibrosis have abnormally high levels of salt in their sweat). An analysis of a sweat sample can determine if cystic fibrosis is the cause of the bronchiectasis. […] For patients whose bronchiectasis doesn’t respond to treatment, a bronchoscopy may be performed to get a video image of the inside of the patient’s airways. This procedure uses a flexible tube with a light at the end that is inserted through the nose or the mouth.

• #41

  https://www.bronchiectasisandntminitiative.org/Learn-More/I-am-a-Patient-or-Caregiver/Diagnostic-Testing-and-Evaluation

  In some cases, your doctor may do a bronchoscopy as part of the evaluation of bronchiectasis and NTM. […] A bronchoscopy is a test that allows your doctor to look at the inside of your lungs using a bronchoscope. […] An ABG is a needle puncture that is done by trained health care workers. […] Arterial blood gas testing is done to help assess treatment, indicate the severity of a condition, or it can be used to evaluate long term use of oxygen therapy.

• #42 Bronchiectasis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Bronchiectasis_differential_diagnosis

  Bronchiectasis must be differentiated from other diseases that cause dyspnea and cough, such as COPD, asthma, pneumonia, tuberculosis, chronic sinusitis, lung cancer, postnasal drip and inhaled foreign body. […] The following investigations may be helpful: Complete blood count (CBC), IgG, IgM and IgA, sputum culture for fungi, bacteria and mycobacteria. […] Linear atelectasis and dilated airways in chest XRay. […] FEV1/FVC 70%, normal FVC, low levels of FEV1. […] CT of chest. […] Digital clubbing, recurrent pleurisy. […] Features that may suggest bronchiectasis in a patient presenting with chronic respiratory symptoms include digital clubbing, lack of a significant smoking history (if COPD is suspected), history of recurrent and/or severe pneumonia or tuberculosis, and presence of either Aspergillus, atypical/nontuberculous Mycobacteria, Pseudomonas aeruginosa, Escherichia coli, or Klebsiella pneumoniae in the sputum.

• #43 Indicators Leading to Bronchiectasis Testing and Diagnosis

  https://www.ajmc.com/view/indicators-leading-to-bronchiectasis-testing-and-diagnosis

  Additional factors that should prompt an evaluation for possible bronchiectasis include underlying diagnoses like immunodeficiencies and certain autoimmune diseases. Severe COPD and asthma can also cause secondary bronchiectasis from chronic airway inflammation. For patients with existing COPD and asthma diagnoses, new onset increased cough frequency and sputum production or purulence could indicate development of bronchiectasis as a complication of the underlying lung disease. […] Ultimately, the development of increased cough and sputum volume/purulence in known asthmatics or COPD patients should prompt consideration of secondary bronchiectasis. Identifying bronchiectasis can allow therapy modifications to improve outcomes.

• #44 Under-diagnosis of Bronchiectasis Hinders Treatment – AffloVest

  https://afflovest.com/underdiagnosis-of-bronchiectasis-hinders-treatment/

  Bronchiectasis (BE) is increasing in prevalence, requiring a greater awareness of the disease. Bronchiectasis most often arises from several different causes. The most common symptom that is associated with a diagnosis is a persistent cough, which is a common presentation in various respiratory diseases and illnesses. The commonality of this symptom is one of the primary reason it often goes undiagnosed. […] Currently healthcare providers are not trained to make bronchiectasis as part of their differential diagnosis work-up when assessing patients with chronic obstructive pulmonary disease (COPD). According to a recent study commissioned, under-diagnosis may be due largely to its similarity in symptoms and grouping under COPD as the clinical features of the COPD and BE frequently overlap. If physicians keep detailed notes on patients’ conditions, it may be possible to reduce misdiagnosis and under-diagnosis, allowing those suffering from bronchiectasis to get the proper treatment they need in order to minimize reinfection and further lung damage.

• #45 Indicators Leading to Bronchiectasis Testing and Diagnosis

  https://www.ajmc.com/view/indicators-leading-to-bronchiectasis-testing-and-diagnosis

  Additional factors that should prompt an evaluation for possible bronchiectasis include underlying diagnoses like immunodeficiencies and certain autoimmune diseases. Severe COPD and asthma can also cause secondary bronchiectasis from chronic airway inflammation. For patients with existing COPD and asthma diagnoses, new onset increased cough frequency and sputum production or purulence could indicate development of bronchiectasis as a complication of the underlying lung disease. […] Ultimately, the development of increased cough and sputum volume/purulence in known asthmatics or COPD patients should prompt consideration of secondary bronchiectasis. Identifying bronchiectasis can allow therapy modifications to improve outcomes.

• #46 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  The gold standard for confirming the diagnosis is high-resolution computed tomography scan of the chest, ideally done when the patient is clinically stable. Determination of the underlying cause may alter management in as many as 37% of adults presenting with bronchiectasis. […] Two validated severity scores are currently used in conjunction with clinical judgment: the FACED score and the Bronchiectasis Severity Index (BSI). The FACED score predicts risk of five-year mortality and is calculated using FEV1% predicted, age, chronic Pseudomonas colonization, extent of bronchiectasis (number of affected lobes) and Medical Research Council Dyspnea Scale score. The BSI can be calculated using an online tool. Predictive variables include age, body mass index, FEV1% predicted, Medical Research Council Dyspnea Scale score, lobes affected and evidence of chronic bacterial infection.

• #47 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  The gold standard for confirming the diagnosis is high-resolution computed tomography scan of the chest, ideally done when the patient is clinically stable. Determination of the underlying cause may alter management in as many as 37% of adults presenting with bronchiectasis. […] Two validated severity scores are currently used in conjunction with clinical judgment: the FACED score and the Bronchiectasis Severity Index (BSI). The FACED score predicts risk of five-year mortality and is calculated using FEV1% predicted, age, chronic Pseudomonas colonization, extent of bronchiectasis (number of affected lobes) and Medical Research Council Dyspnea Scale score. The BSI can be calculated using an online tool. Predictive variables include age, body mass index, FEV1% predicted, Medical Research Council Dyspnea Scale score, lobes affected and evidence of chronic bacterial infection.

• #48 Signs, Symptoms and Diagnosis | trudellmed.com

  https://www.trudellmed.com/global/en/living-bronchiectasis/signs-symptoms-diagnosis

  Tests used to diagnose bronchiectasis in children and adults include: […] Chest CT scan (computed tomography scan) to look at your lungs in more detail […] Mucus (sputum) culture to check for growth of bacteria […] Blood tests to check for conditions associated with bronchiectasis, infection and low levels of infection-fighting blood cells […] Bronchoscopy to look inside your airways. This procedure uses a small camera on the end of a tube called a bronchoscope […] A sweat test or other tests to diagnose cystic fibrosis. […] Scoring systems for bronchiectasis can help your doctor to identify if you’re at higher risk. The Bronchiectasis Severity Index (BSI) uses a combination of clinical, radiological and microbiological features to assess the severity of your disease and to predict future risk of mortality, hospital admissions, exacerbations, and quality of life.

• #49 Signs, Symptoms and Diagnosis | trudellmed.com

  https://www.trudellmed.com/global/en/living-bronchiectasis/signs-symptoms-diagnosis

  Tests used to diagnose bronchiectasis in children and adults include: […] Chest CT scan (computed tomography scan) to look at your lungs in more detail […] Mucus (sputum) culture to check for growth of bacteria […] Blood tests to check for conditions associated with bronchiectasis, infection and low levels of infection-fighting blood cells […] Bronchoscopy to look inside your airways. This procedure uses a small camera on the end of a tube called a bronchoscope […] A sweat test or other tests to diagnose cystic fibrosis. […] Scoring systems for bronchiectasis can help your doctor to identify if you’re at higher risk. The Bronchiectasis Severity Index (BSI) uses a combination of clinical, radiological and microbiological features to assess the severity of your disease and to predict future risk of mortality, hospital admissions, exacerbations, and quality of life.

• #50 Signs, Symptoms and Diagnosis | trudellmed.com

  https://www.trudellmed.com/global/en/living-bronchiectasis/signs-symptoms-diagnosis

  Tests used to diagnose bronchiectasis in children and adults include: […] Chest CT scan (computed tomography scan) to look at your lungs in more detail […] Mucus (sputum) culture to check for growth of bacteria […] Blood tests to check for conditions associated with bronchiectasis, infection and low levels of infection-fighting blood cells […] Bronchoscopy to look inside your airways. This procedure uses a small camera on the end of a tube called a bronchoscope […] A sweat test or other tests to diagnose cystic fibrosis. […] Scoring systems for bronchiectasis can help your doctor to identify if you’re at higher risk. The Bronchiectasis Severity Index (BSI) uses a combination of clinical, radiological and microbiological features to assess the severity of your disease and to predict future risk of mortality, hospital admissions, exacerbations, and quality of life.

• #51 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  The gold standard for confirming the diagnosis is high-resolution computed tomography scan of the chest, ideally done when the patient is clinically stable. Determination of the underlying cause may alter management in as many as 37% of adults presenting with bronchiectasis. […] Two validated severity scores are currently used in conjunction with clinical judgment: the FACED score and the Bronchiectasis Severity Index (BSI). The FACED score predicts risk of five-year mortality and is calculated using FEV1% predicted, age, chronic Pseudomonas colonization, extent of bronchiectasis (number of affected lobes) and Medical Research Council Dyspnea Scale score. The BSI can be calculated using an online tool. Predictive variables include age, body mass index, FEV1% predicted, Medical Research Council Dyspnea Scale score, lobes affected and evidence of chronic bacterial infection.

• #52 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  The gold standard for confirming the diagnosis is high-resolution computed tomography scan of the chest, ideally done when the patient is clinically stable. Determination of the underlying cause may alter management in as many as 37% of adults presenting with bronchiectasis. […] Two validated severity scores are currently used in conjunction with clinical judgment: the FACED score and the Bronchiectasis Severity Index (BSI). The FACED score predicts risk of five-year mortality and is calculated using FEV1% predicted, age, chronic Pseudomonas colonization, extent of bronchiectasis (number of affected lobes) and Medical Research Council Dyspnea Scale score. The BSI can be calculated using an online tool. Predictive variables include age, body mass index, FEV1% predicted, Medical Research Council Dyspnea Scale score, lobes affected and evidence of chronic bacterial infection.

• #53 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  Following a diagnosis of bronchiectasis, it is important to investigate for an underlying cause. Goals of management are to suppress airway infection and inflammation, to improve symptoms and health-related quality of life. There are now validated scoring tools to help assess disease severity, which can help to stratify management. Good evidence supports the use of both exercise training and long-term macrolide therapy in long-term disease management.

• #54 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  The gold standard for confirming the diagnosis is high-resolution computed tomography scan of the chest, ideally done when the patient is clinically stable. Determination of the underlying cause may alter management in as many as 37% of adults presenting with bronchiectasis. […] Two validated severity scores are currently used in conjunction with clinical judgment: the FACED score and the Bronchiectasis Severity Index (BSI). The FACED score predicts risk of five-year mortality and is calculated using FEV1% predicted, age, chronic Pseudomonas colonization, extent of bronchiectasis (number of affected lobes) and Medical Research Council Dyspnea Scale score. The BSI can be calculated using an online tool. Predictive variables include age, body mass index, FEV1% predicted, Medical Research Council Dyspnea Scale score, lobes affected and evidence of chronic bacterial infection.

• #55 Diagnosis and management of bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478409/

  The gold standard for confirming the diagnosis is high-resolution computed tomography scan of the chest, ideally done when the patient is clinically stable. Determination of the underlying cause may alter management in as many as 37% of adults presenting with bronchiectasis. […] Two validated severity scores are currently used in conjunction with clinical judgment: the FACED score and the Bronchiectasis Severity Index (BSI). The FACED score predicts risk of five-year mortality and is calculated using FEV1% predicted, age, chronic Pseudomonas colonization, extent of bronchiectasis (number of affected lobes) and Medical Research Council Dyspnea Scale score. The BSI can be calculated using an online tool. Predictive variables include age, body mass index, FEV1% predicted, Medical Research Council Dyspnea Scale score, lobes affected and evidence of chronic bacterial infection.

• #56 Recommendations for aetiological diagnosis of bronchiectasis | Pulmonology

  https://journalpulmonology.org/en-recommendations-for-aetiological-diagnosis-bronchiectasis-articulo-S2173511516300033

  It is common to assume that the diagnosis is post-infectious BE when symptoms begin after a serious infection. […] If after proper investigation aetiology is still not defined, it is important to be aware of new clinical data throughout the follow up that may require a reassessment. […] In certain cases, where aetiologic diagnoses are considered of exclusion, investigation has to be rigorous. […] The role of AATD in the aetiology of BE has been the subject of debate and contention over the years. […] AATD may play a role which is contributory to, and cumulative with other diseases as the aetiology of BE. […] Patients with BE and clinical features suggestive of PCD should be screened with nasal NO assay according to standardized protocol. […] All patients with BE should be screened for sensitization to A. fumigatus with specific IgE antibody or skin-prick test.

• #57 Recommendations for aetiological diagnosis of bronchiectasis | Pulmonology

  https://www.journalpulmonology.org/en-recommendations-for-aetiological-diagnosis-bronchiectasis-articulo-S2173511516300033

  The number of bronchiectasis diagnoses has increased in the last two decades due to several factors. […] Research carried out over the last years showed that an aetiological diagnosis could change the approach and treatment of a relevant percentage of patients and consequently the prognosis. […] Currently, systematic investigation into aetiology, particularly of those disorders that can be subject to specific treatment, is recommended. […] In conclusion, after diagnosing BE a systematic aetiologic investigation should be undertaken. […] A systematic investigation of the underlying aetiology undertaken according to a predetermined algorithm increases the likelihood of obtaining a diagnosis with better resource management. […] Clinical history should include onset age, presenting symptoms, clinical evolution, previously diagnosed diseases, risk exposures, infertility history, non-respiratory symptoms and family history including consanguinity data.

• #58 Recommendations for aetiological diagnosis of bronchiectasis | Pulmonology

  https://journalpulmonology.org/en-recommendations-for-aetiological-diagnosis-bronchiectasis-articulo-S2173511516300033

  It is common to assume that the diagnosis is post-infectious BE when symptoms begin after a serious infection. […] If after proper investigation aetiology is still not defined, it is important to be aware of new clinical data throughout the follow up that may require a reassessment. […] In certain cases, where aetiologic diagnoses are considered of exclusion, investigation has to be rigorous. […] The role of AATD in the aetiology of BE has been the subject of debate and contention over the years. […] AATD may play a role which is contributory to, and cumulative with other diseases as the aetiology of BE. […] Patients with BE and clinical features suggestive of PCD should be screened with nasal NO assay according to standardized protocol. […] All patients with BE should be screened for sensitization to A. fumigatus with specific IgE antibody or skin-prick test.

• #59 Recommendations for aetiological diagnosis of bronchiectasis | Pulmonology

  https://journalpulmonology.org/en-recommendations-for-aetiological-diagnosis-bronchiectasis-articulo-S2173511516300033

  The presence of BE should be assessed in all patients with PID and PID should be considered in patients with BE. […] Given the strong association of BE with NTM infection it is important to rule out NTM in the following groups of patients with BE. […] The presence of BE in a patient with obstructive airways disease may result from the intersection of prevalences or a causal relationship. […] BE should be suspected in patients with obstructive airway diseases (COPD and asthma) and frequent exacerbations. […] In a Caucasian patient with clinical criteria, lung biopsy should be considered. […] GERD should be suspected in the presence of typical symptoms or patients with poorly controlled respiratory symptoms.

• #60 Diagnosing bronchiectasis | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/healthcare-professionals/bronchiectasis/diagnosing-bronchiectasis

  Many patients will have had exacerbations before they are diagnosed, because they have normalised their symptoms or dont realise that they are significant. […] Gastro-oesophageal reflux disease is common in bronchiectasis and associated with more frequent respiratory exacerbations. […] Chronic rhinosinusitis is present in up to 70% of cases of bronchiectasis and should be treated to protect the airways. […] A normal chest X-ray does not rule out bronchiectasis so if clinical suspicion remains high, refer to secondary care for a high-resolution CT chest scan. […] In bronchiectasis, the spirometry might be obstructive, restrictive or normal. […] Once your patient is diagnosed, the specialist team in secondary care will undertake additional blood testing for alpha-1 antitrypsin, immunoglobulins, auto antibodies, aspergillus and pneumococcal antibody levels.

• #61 Recommendations for aetiological diagnosis of bronchiectasis | Pulmonology

  https://www.journalpulmonology.org/en-recommendations-for-aetiological-diagnosis-bronchiectasis-articulo-S2173511516300033

  The presence of BE should be assessed in all patients with PID and PID should be considered in patients with BE. […] BE should be suspected in patients with obstructive airway diseases (COPD and asthma) and frequent exacerbations. […] The prevalence of BE in patients with COPD is highly variable (27-74%). […] The prevalence of BE in asthma is described between 17.5 and 28%. […] The prevalence of BE in PBD is 100% in advanced stages. […] The causal relationship between GERD and BE is controversial, especially in adults, but it is recognized that GERD could have a negative clinical impact on BE patients. […] The prevalence of GERD in BE was 40%, of whom 42% had clinically silent reflux.

• #62 Bronchiectasis – Pulmonary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pulmonary-disorders/bronchiectasis-and-atelectasis/bronchiectasis

  Bronchoscopy is indicated when an anatomic or obstructive lesion is suspected as the cause of bronchiectasis. […] A bronchiectasis exacerbation is defined as a patient with bronchiectasis with deterioration for at least 48 hours and 3 of the following symptoms: Breathlessness and/or exercise intolerance, Cough, Fatigue and/or malaise, Hemoptysis, Increase in sputum purulence, Increase in sputum volume and/or consistency.

• #63 Bronchiectasis: diagnosis, treatment and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/bronchiectasis-diagnosis-treatment-and-management

  Variable lung function tests can be seen in patients with bronchiectasis, even in people with more severe disease (some may have normal spirometry, a restrictive defect or airway obstruction). […] Despite being quite non-specific, chest x-rays are often the initial mode of imaging used for investigating bronchiectasis. However, changes are only notable in severe disease, therefore, a normal chest x-ray does not exclude bronchiectasis. A high-resolution CT scan of the chest is considered the radiological investigation of choice. […] If CT imaging shows localised disease, bronchoscopy is recommended to exclude an endobronchial lesion. Bronchoscopy with broncho-alveolar lavage is also useful in patients with suspected NTM infection who cannot produce regular sputum. […] The British Thoracic Society (BTS) guidelines define an exacerbation as needing antibiotics and an acute deterioration with worsening symptoms (cough, increased sputum volume or change of viscosity, increased sputum purulence with or without increasing wheeze, breathlessness, haemoptysis) and/or systemic upset.

• #64 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  Regular clinic visits will allow the primary care provider to coordinate care with specialists and refer the patient to the appropriate specialist, as needed. […] Spirometry is a key pulmonary function test used to assess lung function and should be performed at least annually, and preferably at each clinic visit in patients with severe bronchiectasis. […] The discussion between the primary care provider and patient during these routine visits provides an opportunity for ongoing patient education, a key component of disease management. […] An exacerbation can be defined as a significant worsening of symptoms over several days, which may include an increase in the frequency of cough, shortness of breath, increase of sputum volume, viscosity and/or purulence. […] Patients requiring intravenous antibiotics include those with severe infections requiring hospital admission, patients with organisms resistant to oral antibiotic agents or patients who have failed to improve with 14 days of targeted oral antibiotics.

• #65 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  Regular clinic visits will allow the primary care provider to coordinate care with specialists and refer the patient to the appropriate specialist, as needed. […] Spirometry is a key pulmonary function test used to assess lung function and should be performed at least annually, and preferably at each clinic visit in patients with severe bronchiectasis. […] The discussion between the primary care provider and patient during these routine visits provides an opportunity for ongoing patient education, a key component of disease management. […] An exacerbation can be defined as a significant worsening of symptoms over several days, which may include an increase in the frequency of cough, shortness of breath, increase of sputum volume, viscosity and/or purulence. […] Patients requiring intravenous antibiotics include those with severe infections requiring hospital admission, patients with organisms resistant to oral antibiotic agents or patients who have failed to improve with 14 days of targeted oral antibiotics.

• #66 Bronchiectasis A guide for primary care

  https://www.racgp.org.au/afp/2012/november/bronchiectasis

  The principles of ongoing management of bronchiectasis are based on the monitoring of severity, reducing progression and complications, early treatment of acute exacerbations, minimising disability, considering transplantation in appropriate patients, managing comorbidities and early utilisation of palliative care services when necessary. […] In general, all patients should be discussed or referred to a specialist paediatric or adult respiratory physician for initial assessment and advice regarding the development of an individualised management plan. […] While bacteria and fungi are often found in the sputum of people with bronchiectasis, their role in disease development, acute exacerbations and progression is variable. […] An acute exacerbation can be defined as two or more of: increasing cough, shortness of breath, increasing volume/purulence of sputum.

• #67 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  Regular clinic visits will allow the primary care provider to coordinate care with specialists and refer the patient to the appropriate specialist, as needed. […] Spirometry is a key pulmonary function test used to assess lung function and should be performed at least annually, and preferably at each clinic visit in patients with severe bronchiectasis. […] The discussion between the primary care provider and patient during these routine visits provides an opportunity for ongoing patient education, a key component of disease management. […] An exacerbation can be defined as a significant worsening of symptoms over several days, which may include an increase in the frequency of cough, shortness of breath, increase of sputum volume, viscosity and/or purulence. […] Patients requiring intravenous antibiotics include those with severe infections requiring hospital admission, patients with organisms resistant to oral antibiotic agents or patients who have failed to improve with 14 days of targeted oral antibiotics.

• #68

  https://www.rethinkbronchiectasis.com/disease-overview/

  Bronchiectasis initially presents with chronic cough and sputum production in addition to recurrent exacerbations. […] A definitive diagnosis of bronchiectasis requires both clinical criteria and radiological evidence. […] Clinical suspicion includes presence of symptoms and history of exacerbations. […] Findings on imaging include dilated airways, lack of airway tapering, and airway visibility in the periphery. […] Exacerbations are important for a lot of reasons. One is because patients feel poorly when they have them, and we would therefore like to try and prevent them, or treat them rapidly when they occur. […] We believe that exacerbations are part of what drives the ongoing inflammation and progression of bronchiectasis. […] We know they’re associated with some bad outcomes, worsening quality of life, and, very importantly, disease progression, and even mortality.

• #69

  https://www.rethinkbronchiectasis.com/disease-overview/

  It’s very important to identify these exacerbations and treat it appropriately early. […] Exacerbations can negatively affect patients and their families, and are associated with significant anxiety, lack of control, decreased quality of life, embarrassment, and work and social interruptions. […] Most patients with bronchiectasis experience 1 or more exacerbations, resulting in greater disease burden over time. […] Pulmonary exacerbation defined here as an inpatient claim with a non-cystic fibrosis bronchiectasis diagnosis or a healthcare interaction, followed by an antibiotic prescription within 7 days.

• #70 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  Regular clinic visits will allow the primary care provider to coordinate care with specialists and refer the patient to the appropriate specialist, as needed. […] Spirometry is a key pulmonary function test used to assess lung function and should be performed at least annually, and preferably at each clinic visit in patients with severe bronchiectasis. […] The discussion between the primary care provider and patient during these routine visits provides an opportunity for ongoing patient education, a key component of disease management. […] An exacerbation can be defined as a significant worsening of symptoms over several days, which may include an increase in the frequency of cough, shortness of breath, increase of sputum volume, viscosity and/or purulence. […] Patients requiring intravenous antibiotics include those with severe infections requiring hospital admission, patients with organisms resistant to oral antibiotic agents or patients who have failed to improve with 14 days of targeted oral antibiotics.

• #71 Bronchiectasis A guide for primary care

  https://www.racgp.org.au/afp/2012/november/bronchiectasis

  While there is little evidence to support the use of antibiotics in acute exacerbations of bronchiectasis, there is general consensus that they should be used. […] The management of bronchiectasis is complicated, multifaceted and requires the coordination of a broad range of healthcare providers. […] Given bronchiectasis is a chronic disease that can be associated with both long term disability, as well as less marked premature mortality, the importance of structured care as part of regular primary care review and reassessment is the key to successful management.

• #72 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  Regular clinic visits will allow the primary care provider to coordinate care with specialists and refer the patient to the appropriate specialist, as needed. […] Spirometry is a key pulmonary function test used to assess lung function and should be performed at least annually, and preferably at each clinic visit in patients with severe bronchiectasis. […] The discussion between the primary care provider and patient during these routine visits provides an opportunity for ongoing patient education, a key component of disease management. […] An exacerbation can be defined as a significant worsening of symptoms over several days, which may include an increase in the frequency of cough, shortness of breath, increase of sputum volume, viscosity and/or purulence. […] Patients requiring intravenous antibiotics include those with severe infections requiring hospital admission, patients with organisms resistant to oral antibiotic agents or patients who have failed to improve with 14 days of targeted oral antibiotics.

• #73 Emerging Concepts in Bronchiectasis: Diagnosis, Pathophysiology, and Relevance in Lung Disease – European Medical Journal

  https://www.emjreviews.com/respiratory/symposium/emerging-concepts-in-bronchiectasis-diagnosis-pathophysiology-and-relevance-in-lung-disease-j160124/

  Trudzinski stressed that all patients with bronchiectasis should undergo an aetiological workup, which includes a review of their medical history, clinical findings, and radiological findings, and a minimum bundle of laboratory tests. […] The minimum bundle of aetiological tests recommended by the ERS for adults with a new diagnosis of bronchiectasis includes differential blood count to detect primary or secondary immunodeficiency, serum immunoglobins (total IgG, IgA, and IgM), and testing for allergic bronchopulmonary aspergillosis (ABPA). […] Trudzinski emphasised that following the ERS recommendations can help to understand the aetiology of bronchiectasis, and can lead to relevant changes in treatment and prognosis. […] However, she explained that once bronchiectasis has been accurately diagnosed, additional CT scans are rarely useful unless the clinical manifestations of the disease have changed considerably; in patients with relatively stable disease, Trudzinski tends to perform a CT scan every five years.

• #74 Emerging Concepts in Bronchiectasis: Diagnosis, Pathophysiology, and Relevance in Lung Disease – European Medical Journal

  https://www.emjreviews.com/respiratory/symposium/emerging-concepts-in-bronchiectasis-diagnosis-pathophysiology-and-relevance-in-lung-disease-j160124/

  Trudzinski stressed that all patients with bronchiectasis should undergo an aetiological workup, which includes a review of their medical history, clinical findings, and radiological findings, and a minimum bundle of laboratory tests. […] The minimum bundle of aetiological tests recommended by the ERS for adults with a new diagnosis of bronchiectasis includes differential blood count to detect primary or secondary immunodeficiency, serum immunoglobins (total IgG, IgA, and IgM), and testing for allergic bronchopulmonary aspergillosis (ABPA). […] Trudzinski emphasised that following the ERS recommendations can help to understand the aetiology of bronchiectasis, and can lead to relevant changes in treatment and prognosis. […] However, she explained that once bronchiectasis has been accurately diagnosed, additional CT scans are rarely useful unless the clinical manifestations of the disease have changed considerably; in patients with relatively stable disease, Trudzinski tends to perform a CT scan every five years.

• #75 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  Bronchiectasis is a chronic lung disease characterised by recurrent infection, inflammation, persistent cough and sputum production. […] Initial assessments and long-term treatment plans that include both pharmacological and non-pharmacological treatments, however, should be undertaken in collaboration with a secondary care team that includes physiotherapists and specialists in respiratory medicine. […] Overall goals of therapy are to prevent exacerbations, improve symptoms, improve quality of life and preserve lung function. […] Prompt treatment of exacerbations with antibiotic therapy is important to limit the impact of exacerbations on quality of life and lung function decline. […] It is important for the primary care provider to work with secondary care providers to develop an individualised treatment plan to optimise care with the goal to delay disease progression.

• #76 Bronchiectasis A guide for primary care

  https://www.racgp.org.au/afp/2012/november/bronchiectasis

  While there is little evidence to support the use of antibiotics in acute exacerbations of bronchiectasis, there is general consensus that they should be used. […] The management of bronchiectasis is complicated, multifaceted and requires the coordination of a broad range of healthcare providers. […] Given bronchiectasis is a chronic disease that can be associated with both long term disability, as well as less marked premature mortality, the importance of structured care as part of regular primary care review and reassessment is the key to successful management.

• #77 Bronchiectasis A guide for primary care

  https://www.racgp.org.au/afp/2012/november/bronchiectasis

  While there is little evidence to support the use of antibiotics in acute exacerbations of bronchiectasis, there is general consensus that they should be used. […] The management of bronchiectasis is complicated, multifaceted and requires the coordination of a broad range of healthcare providers. […] Given bronchiectasis is a chronic disease that can be associated with both long term disability, as well as less marked premature mortality, the importance of structured care as part of regular primary care review and reassessment is the key to successful management.

• #78 Get Bronchiectasis Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/bronchiectasis-treatment

  Imaging tests create detailed pictures and views that help our experts find out whats happening inside your lungs. You may have a: Bronchoscopy, Chest X-ray, CT scan of your chest. […] Our specialists do pulmonary function testing to learn more about how your lungs work. We use these tests to see if you have any blockages or other conditions that are keeping you from breathing as you should. […] When you come to Cleveland Clinic for bronchiectasis diagnosis and treatment, youll see providers from every aspect of pulmonary (lung) care, and similar specialties. We work together and with you to keep your airways clear and free from infection.

• #79 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  When P. aeruginosa is isolated for the first time in patients with bronchiectasis most international guidelines recommend attempting to eradicate the organism when isolated for the first time in sputum. […] Once a patient is diagnosed, he or she should be referred to secondary care for assessment and to help determine the underlying cause of the disease.

• #80 Diagnosing bronchiectasis | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/healthcare-professionals/bronchiectasis/diagnosing-bronchiectasis

  The diagnosis of bronchiectasis is made from a high-resolution CT scan. […] Usually the patient journey starts with a patient presenting with symptoms to their GP practice. They should be assessed, relevant tests performed and then referred for a CT scan if appropriate. Most patients then receive their diagnosis from a specialist in secondary care. […] After diagnosis, patients should be seen by the specialist respiratory team to create a care plan thats agreed together with the patient, the specialist team and the primary care team. […] A recurrent productive cough (one that has lasted for 8 weeks or longer) is a key sign of bronchiectasis. […] Sputum colour can suggest infection (if green or brown) and any blood in the sputum (haemoptysis). […] Haemoptysis can be a sign of bronchiectasis but is also associated with lung cancer so will need further investigation.

• #81 Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-017-0019-9

  If HRCT is not indicative of bronchiectasis, then the diagnosis can be excluded. […] Knowing which pathogen is present, if any, will help determine the most effective antibiotic treatment. […] A regular chest x-ray may be insensitive to the changes caused by bronchiectasis. […] Negative sputum cultures do not exclude a diagnosis of bronchiectasis. […] The bronchiectasis severity index has recently been developed and extensively validated and may enhance the ability of physicians to predict outcomes and better manage patient care. […] The main goals of treatment are to reduce exacerbations, preserve lung function and improve the patients quality of life. […] Specific management strategies for bronchiectasis depend on the underlying severity and cause of disease. […] Patients with mild or moderate bronchiectasis are often managed and monitored in the primary care setting.

• #82 Bronchiectasis Diagnosis: What is Bronchiectasis?

  https://www.nationaljewish.org/conditions/bronchiectasis/overview/diagnosis-prognosis

  The first step in diagnosing bronchiectasis is a thorough evaluation. Your doctor may have you do a number of tests to evaluate your breathing. […] A multiple step process usually leads to the diagnosis of bronchiectasis. Many factors are considered. […] The evaluation for bronchiectasis often includes: A complete medical history, A complete physical examination, A chest CT scan (a specialized X-ray which produces detailed slice-like pictures) of the lungs, Breathing tests, called pulmonary function tests. These determine the presence and severity of abnormal airflow out of the lungs, Specific screening or diagnostic tests for some of the possible underlying diseases that may cause bronchiectasis, based on the history and physical exam. […] Doctors at National Jewish Health have evaluated and treated bronchiectasis for decades. […] Remember that the gold standard to make a diagnosis of bronchiectasis is now a high resolution CT scan of the lungs and NOT a simple chest xray.

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